医患沟通系统评价证据的循证分析_《中国循证医学杂志》

作者：

卫茂玲 ¹ , 苏维 ² , 李幼平 ¹ , 康德英 ¹ , 宋儒亮 ³ , 张鸣明 ¹

1. 四川大学华西医院中国循证医学中心（成都 610041)； 2. 四川大学华西公共卫生学院（成都 610041）；3. 广东省律师协会医疗法律专业委员会（广州 510053）;

关键词：

医患沟通医患关系循证医学系统评价

DOI：

10.7507/1672-2531.20080240

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　采用循证医学文献质量评价方法，寻找医患沟通系统评价证据，为建立我国医患有效沟通模式提供依据。
方法　全面检索与医患关系和沟通交流主题相关的中英文系统评价或Meta分析相关文献，并追索参考文献及其索引，检索时间截至2008年3月30日。由两名评价员独立筛查文献，根据系统评价量表（OQAQ）对纳入文献质量进行再评价，如遇分歧讨论解决。
结果　共纳入与医患沟通相关的系统评价17篇，OQAQ量表评分，最高9分，最低为3分，其中9个条目平均符合率为66.01%（中位数为6），7～9分段占41.29%（7/17），6分占23.5%（4/17），3～5分段占35.3%（6/17）。影响医患沟通的主要因素有沟通对象、沟通时间、内容、方式等。沟通策略包括以不同模板分别对病人行为进行引导和对医护沟通技能进行针对性培训等。
结论　现有关于医患沟通的系统评价主要基于欧美国家，这反映出我国相关研究不足。基于现有证据，目前应建立鼓励沟通机制和文化，主动发现医患沟通问题和阻断不良沟通行为，同时关注病人意愿，合理选择培训策略，及时评估反馈，以提高医患沟通满意度。

引用本文： 卫茂玲,苏维,李幼平,康德英,宋儒亮,张鸣明. 医患沟通系统评价证据的循证分析. 中国循证医学杂志, 2008, 08(12): 1100-1104. doi: 10.7507/1672-2531.20080240 复制

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2.	张鹭鹭, 李静, 徐祖铭. 主编. 高级医院管理学. 上海: 第二军医大学出版社, 2003.
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9.	Rao M. Fogarty P. What did the doctor say? J Obstet Gynaecol (Lahore), 2007, 27(5): 479-480.
10.	Murden RA, Way DP, Hudson A, et al. Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school. Acad Med, 2004, 79(10 Suppl): S46-48.
11.	Fallowfield L, Jenkins V, Farewell V, et al. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet, 2002, 359(9307): 650-656.
12.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
13.	Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
14.	Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients and healthcare practitioners for improving patients’ adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004808. DOI: 10.1002/14651858.CD004808.pub3.
15.	McKinstry B, Ashcroft RE, Freeman GK, et al. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004134. DOI: 10.1002/14651858.CD004134.pub2.
16.	Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003267. DOI: 10.1002/14651858.CD003267.
17.	R Urquhart CC, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.
18.	Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations for helping patients address their information needs. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004565. DOI: 10.1002/14651858.CD004565.pub2.
19.	Rao JK, Anderson LA, Inui TS, et al. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care, 2007, 45(4): 340-349.
20.	Griffin SJ, Kinmonth AL, Veltman MW, et al. Effect on healthrelated outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med, 2004, 2(6): 595-608.
21.	Krishna SB, Spencer DC, Griffin J Z, et al. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract, 1997, 45(1): 25-33.
22.	Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract, 1997, 14(2): 160-176.
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24.	Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care, 2000, 38(2): 175-186.
25.	Moxey A, O’Connell D, McGettigan P, et al. Describing treatment effects to patients. J Gen Intern Med, 2003, 18(11): 948-959.
26.	Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev, 2005, 62(3): 255-99.
27.	Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns, 2004, 52(1): 7-16.
28.	Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician, 2002, 48: 72-80.
29.	Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet, 2001, 357(9258): 757-762.
30.	Sullivan F, Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ, 1995, 311(7009): 848-852.
31.	Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ, 2005, 39(6): 645.
32.	Merckaert I, Libert Y, Razavi D. Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol, 2005,17(4): 319-330.
33.	Oskay-O¨ zcelik G, Lehmacher DW, Ko¨ nsgen H, et al. Breast cancer patients’expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol, 2007, 18: 479-484.

1. 江波, 刘景双. 主编. 医患关系新论. 大连理工大学出版社. 1998年 3月.
2. 张鹭鹭, 李静, 徐祖铭. 主编. 高级医院管理学. 上海: 第二军医大学出版社, 2003.
3. 邱仁宗. 临床医师面临的若干伦理问题, 中国医院, 2003, 7(4): 18-21.
4. 王玉华, 刘刚, 吴锦萍, 等. 云南省医疗纠纷调查分析. 医学与社会, 2007, 20(9): 33-35.
5. 中国医师协会. 在全国部分省市调查“医闹”的分析报告. 中国卫生产业, 2007, (2): 57-59.
6. 中华医院管理学会维权与自律工作委员会, 中华医院管理学会维权工作部.《医疗事故处理条例》实施后医疗纠纷的调查分析. 中国医院, 2004, 8(3): 8.
7. 滕朝宇, 张德茗. 湘雅二医院医患沟通研究. 中国优秀硕士学位论文全文数据库, 2006.
8. Greene MG, Adelman RD, Friedmann E, et al. Older patient satisfaction with communication during an initial medical encounter. Soc Sci Med, 1994, 8(9): 1279-1288.
9. Rao M. Fogarty P. What did the doctor say? J Obstet Gynaecol (Lahore), 2007, 27(5): 479-480.
10. Murden RA, Way DP, Hudson A, et al. Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school. Acad Med, 2004, 79(10 Suppl): S46-48.
11. Fallowfield L, Jenkins V, Farewell V, et al. Efficacy of a Cancer Research UK communication skills training model for oncologists: a randomised controlled trial. Lancet, 2002, 359(9307): 650-656.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008]. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
13. Oxman AD, Guyatt GH. Validation of an index of the quality of review articles. J Clin Epidemiol, 1991, 44(11): 1271-1278.
14. Bosch-Capblanch X, Abba K, Prictor M, et al. Contracts between patients and healthcare practitioners for improving patients’ adherence to treatment, prevention and health promotion activities. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004808. DOI: 10.1002/14651858.CD004808.pub3.
15. McKinstry B, Ashcroft RE, Freeman GK, et al. Interventions for improving patients’ trust in doctors and groups of doctors. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004134. DOI: 10.1002/14651858.CD004134.pub2.
16. Lewin SA, Skea ZC, Entwistle V, et al. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003267. DOI: 10.1002/14651858.CD003267.
17. R Urquhart CC, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.
18. Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations for helping patients address their information needs. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004565. DOI: 10.1002/14651858.CD004565.pub2.
19. Rao JK, Anderson LA, Inui TS, et al. Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence. Med Care, 2007, 45(4): 340-349.
20. Griffin SJ, Kinmonth AL, Veltman MW, et al. Effect on healthrelated outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med, 2004, 2(6): 595-608.
21. Krishna SB, Spencer DC, Griffin J Z, et al. Clinical trials of interactive computerized patient education: implications for family practice. J Fam Pract, 1997, 45(1): 25-33.
22. Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract, 1997, 14(2): 160-176.
23. Wilson A, Childs S. The relationship between consultation length, process and outcomes in general practice: a systematic review. Br J Gen Pract, 2002, 52(485): 1012-1020.
24. Espallargues M, Valderas JM, Alonso J. Provision of feedback on perceived health status to health care professionals: a systematic review of its impact. Med Care, 2000, 38(2): 175-186.
25. Moxey A, O’Connell D, McGettigan P, et al. Describing treatment effects to patients. J Gen Intern Med, 2003, 18(11): 948-959.
26. Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev, 2005, 62(3): 255-99.
27. Harrington J, Noble LM, Newman SP. Improving patients’ communication with doctors: a systematic review of intervention studies. Patient Educ Couns, 2004, 52(1): 7-16.
28. Petrella RJ, Lattanzio CN. Does counseling help patients get active? Systematic review of the literature. Can Fam Physician, 2002, 48: 72-80.
29. Di Blasi Z, Harkness E, Ernst E, et al. Influence of context effects on health outcomes: a systematic review. Lancet, 2001, 357(9258): 757-762.
30. Sullivan F, Mitchell E. Has general practitioner computing made a difference to patient care? A systematic review of published reports. BMJ, 1995, 311(7009): 848-852.
31. Roter DL, Larson S, Shinitzky H, et al. Use of an innovative video feedback technique to enhance communication skills training. Med Educ, 2005, 39(6): 645.
32. Merckaert I, Libert Y, Razavi D. Communication skills training in cancer care: where are we and where are we going? Curr Opin Oncol, 2005,17(4): 319-330.
33. Oskay-O¨ zcelik G, Lehmacher DW, Ko¨ nsgen H, et al. Breast cancer patients’expectations in respect of the physician–patient relationship and treatment management results of a survey of 617 patients. Ann Oncol, 2007, 18: 479-484.

《中国循证医学杂志》

医患沟通系统评价证据的循证分析

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《中国循证医学杂志》

医患沟通系统评价证据的循证分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

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